A comparative study on treatment seeking behaviour of geriatric population in rural and urban areas of district Kanpur, Uttar Pradesh

Background: Aging is a complex and universal life process. Treatment seeking behaviour in elderly is affected by socioeconomic factors and by affordability, availability and accessibility of healthcare. Objectives: To study treatment-seeking behaviour of the study subjects. To compare treatment seeking behaviour among rural and urban study subjects. Methods: This was a cross-sectional study conducted in the Kanpur district. Selection of villages in rural and mohallas in urban areas was done using a multistage random sampling technique. A total of 600 subjects were studied, including 400 from urban areas and 200 from rural areas. Elderly persons>60 years of age, both males and females were included in the study. Results: Overall, out of 600 study subjects, 59.8% were taking treatment in rural areas and in urban areas 77.6% were taking treatment. In urban areas, more females availed treatment compared to rural areas. Majority of study subjects (56.5%) sought treatment from a government hospital. Only 36% subjects had health insurance. Conclusion: In Urban areas more subjects availed treatment as compared to rural areas. Majority of subjects sought treatment from government health facilities. Lack of financial support and long waiting time were major reasons for not availing health care.

A retrospective cross-sectional study to evaluate the adverse drug reactions reported in the tertiary care health center in Northern India

Background: In terms of morbidity and death, adverse drug reactions (ADR) have been highlighted as a worldwide burden. Determining the origin of ADRs remains a tough issue and no one approach for determining causation has been adopted as the gold standard throughout the world. Aim and Objectives: The objectives of the present study were (1) to evaluate the causality of ADRs using World Health Organization-Uppsala Monitoring Center (WHO-UMC) and Naranjo Algorithm ADRs causality assessment tools and (2) to evaluate the agreement and correlation between two universally used approaches for causality assessment of ADRs viz. WHO-UMC system and Naranjo algorithm. The secondary objective was to assess the reported ADRs in a tertiary care hospital in Northern India. Materials and Methods: The present study was a retrospective cross-sectional study. A total of 180 patients of ADRs from different departments of tertiary care hospital which were reported by Pharmacovigilance unit over a period of April 2018 to May 2019 were assessed. The causality assessment for these reported ADRs were done by WHO-UMC system and Naranjo algorithm. The agreement between these two methods calculated by Cohen’s kappa (?) statistics and Spearman’s correlation was used to evaluate the correlation between these two methods. Results: According to WHO-UMC criteria, 55.5% of adverse event instances were of the probable type, 34.4% were possible, 9.4% of cases were improbable, and 0.5% of cases were definite. According to the Naranjo methodology, 80.5% of adverse outcomes were likely, while 19.4% were feasible. The WHO and Naranjo causality comparisons had a positive and fair agreement (= 0.29), according to Cohen’s kappa test. Between the WHO-UMC scale and the Naranjo algorithm, the Spearman’s correlation coefficient was determined to be 0.409. Conclusion: “Probable” was the most common causality category observed by the WHO-UMC scale and the Naranjo algorithm. The WHO-UMC scale and the Naranjo algorithm have a good and reasonable agreement.

Impact of co-morbidities in COVID -19 infected patients

Background- During the COVID- 19 pandemic in the first wave, infected patients age was range from 4 weeks to 90 years and those who have more age and with comorbidities are more susceptible to develop serious illness and have high mortality rates. Objective-To study the association between survivor vs non survivor on the basis of demographic profile and high risk factors. Material & methods: This study was done in the Government Medical College, Kannauj on the COVID-19 patients who were admitted in the isolation wards, from 1st September 2020 to December 31st 2020. Statistical Analysis- Analysis was done using SPSS- 23 trial version software. Results: case fatality rate was 2.7% in this study. Most common symptoms was cough (61.0%) and among these admitted patients the most common comorbidities was hypertension (26.7%), followed by diabetes (20.7%), and COPD (14.0%) respectively. Platelets (< 0.02), post prandial blood sugar (PPBS) (< 0.01) have significant role in survivability of COVID- 19 patients. Conclusion: This study concludes that those patients who were older in age and with comorbidity especially (hypertension, COPD, high PPBS, High platelets) have poorer prognosis as compare to those without.

Qualitative analyses of lignocellulolytic enzymes produced by Emericella sp strain HST9 under diverse culture conditions

Aim: Optimization of cultural conditions for improved lignocellulolytic enzyme production by an ascomycete HST9 isolated from leaf and litter waste. Methodology: The fungus HST9 was isolated from leaf and litter waste collected from Chaudhary Charan Singh Haryana Agricultural University, Hisar, India. Culture experiments were conducted at different temperature, pH, incubation periods and aeration conditions. Effects of addition of different concentrations of various metal ions, different carbon complexes and nitrogen salts on enzyme production were also studied under submerged culture condition. Enzyme activities were measured by standard protocols using spectrophotometer. Results: HST9 grew well and produced optimum enzymes at 30oC on 7th day of incubation at stationary conditions and pH- 6. Overall enzyme activities decreased after addition of metal salts. Carboxymethyl cellulose (300 mg l-1) and alkali lignin (200 mg l-1) were observed to be the best carbon complexes for cellulolytic and ligninolytic activities. Ammonium sulfate was found to be a better nitrogen source compared to others. Under optimum conditions, different enzyme activities observed were 0.011 IU m l-1 FPase, 0.015 IU ml-1 CMCase, 6.5 IU m l-1 Lac, 57.5 IU m l-1 LiP and 4 IU ml-1 MnP. Molecular phylogenetic analysis of the strain confirmed that strain HST9 showed closeness with genus Emericella. Interpretation: Lignocellulolytic enzyme activity of Emericella isolate HST9 enhanced at optimum culture conditions, signifying that it can be used as a biological agent to degrade lignocellulosic waste.

Metabolic Syndrome in psoriasis: a hospital based cross-sectional study in Central India

Background: Psoriasis is a chronic immune-mediated inflammatory disorder, reported to be associated with obesity, dyslipidaemia and diabetes via common immunological mechanisms. All of these components ultimately increase the risk of metabolic syndrome and cardiovascular morbidities. Aims and Objectives: To assess the association of Metabolic Syndrome (MS) and its components in patients suffering from psoriasis. To study the relationship between the duration and severity of psoriasis and MS. Materials and Methods: A hospital based cross-sectional study was conducted involving 100 adult patients with psoriasis and 100 controls. All participants were evaluated forpsoriasis and the components of MS. Psoriasis was categorized as mild, moderate and severe based on Psoriasis Area and Severity Index (PASI) (<7, 8–12 and >12, respectively). In all patients and controls, body mass index was calculated, blood pressure and waist circumference were measured and fasting blood sugar and lipid profile were estimated. Results: In the present study, a higher prevalence of MS in Psoriasis patients than in controls (38% v/s 23%) was observed. Psoriatic patients had higher prevalence of hypertension (36% v/s 14%). It can be concluded that association of MS and psoriasis is independent of the type, duration and severity of psoriasis. Conclusion: The present study suggests that subjects with psoriasis present a greater risk of MS and should trigger a higher clinical suspicion for their co-existence. Psoriasis is a systemic disease with significant morbidity and mortality. This study emphasizes the critical need for providers to screen psoriasis patients for early diagnosis and treatment of associated MS. However, more number of large population based cohort studies are required to establish stronger association between psoriasis and MS.

BRAFV600E mutation in hairy cell leukemia: A single-center experience

Background: BRAFV600E mutation has been reported as a unique genetic lesion of hairy cell leukemia (HCL), a subset of which lacks this lesion and shows adverse outcomes. Aims: To determine the prevalence of BRAFV600E in HCL from our center and derive clinicopathological correlation, if any. Materials and Methods: A 9-year retrospective analysis of 46 consecutive cases of HCL diagnosed on morphology and immunophenotyping was done. Stained smears were used as samples for amplification refractory mutation system polymerase-chain reaction using fluorescent primers for mutation detection. Results: BRAFV600E mutation was detected in 41/46 patients (89.1%) while absent in control samples of chronic lymphocytic leukemia. Cases mimicking HCL-variant clinically or immunophenotypically too showed the presence of this mutation. HCL with mutated BRAF presented at a younger age. No statistical difference in blood counts, tumor load, and immunophenotype patterns existed among BRAF mutated and unmutated group. Nine patients (45%) with mutated BRAF had residual disease following treatment with cladribine. Conclusion: BRAFV600E mutation analysis has a definitive role in the diagnosis of HCL.

Molecular genetics of BCR-ABL1 negative myeloproliferative neoplasms in India

Introduction: Over the past decade, we have moved on from a predominantly morphological and clinical classification of myeloproliferative neoplasms (MPN) to a more evolved classification that accounts for the molecular heterogeneity that is unique to this subgroup of hematological malignancies. This usually incorporates mutations in Janus kinase 2 (JAK2), MPL, and calreticulin (CALR) genes. In this manuscript, we report the frequency of these mutations in a cohort of Indian patients at a tertiary cancer center. Materials and Methods: One hundred and thirty cases of MPN were included in this study. These cases were diagnosed and classified based on the World Health Organization 2008 criteria. JAK2 and MPL mutations were detected using high sensitivity allele-specific polymerase chain reaction using fluorescent labeled primers followed by capillary electrophoresis. A subset of JAK2 and CALR mutations were assessed using a fragment length assay. Results: Among the MPN, we had 20 cases of polycythemia vera (PV), 34 cases of essential thrombocythemia (ET), and 59 of myelofibrosis (MF). JAK2, MPL, and CALR mutations were mutually exclusive of each other. Seventeen cases were categorized as MPN unclassifiable (MPN-U). JAK2p.V617F and MPL mutations were present in 60% (78 of 130) and 5.3% (7 of 130) of all MPN. All the PV cases harbored the JAK2 p.V617F mutation. A total of 23.8% (31 of 130) of patients harbored CALR mutations. CALR exon 9 mutations were detected in 60.8% (14 of 23) and 50% (5 of 10) of JAK2 and MPL negative MF and ET cases, respectively. MPN-U cases included three JAK2 p.V617F positive, two MPL p.W515 L, and 12 CALR positive cases. Ten different types of CALR indels (8 deletions and 2 insertions) were detected of which Type I and Type II mutations were the most common, occurring at a frequency of 45.1% (14 of 31) and 22.5% (7 of 31), respectively. Discussion and Conclusion: We report frequencies of JAK2 p. V617F, MPL exon 10 and CALR mutations in 130 patients similar to those reported in western literature. These mutations carry not only diagnostic but also prognostic relevance.

Catheterization related urethral injury in periphery due to improper technique

Background and Objectives: Catheterization related urethral injury (CRUI), particularly in men, is common and produces significant morbidity. However, it seems to have gathered little interest of concerned authorities towards prevention. The objective of the study is to reveal that many CRUI are usually due to improper technique.Material and Methods: This is a retrospective and descriptive study carried out at Janaki Medical College & Teaching Hospital, Janakpur between May 2013 and September 2016. It included 18 male patients presenting in emergency with acute CRUI. Re-catheterization was attempted by experienced surgeons in them unless there was history suggestive of urethral stricture and the outcome was analyzed.Results: Mean age of the patients was 62.9 ± 17.7 (range: 22 - 90) years. When the consultant attended them, 8 (44.4%) patients had catheter in place with intraurethral balloon inflation (IUBI), and 10 patients had catheter removed. One patient in each group had scrotal hematoma suggesting urethral perforation. Excluding two patients with typical history suggestive of urethral stricture, manual urethral re-catheterization was attempted by surgeon in 16 patients and succeeded in 12 (75%) patients, which was remarkable. Rest of the 6 patients had suprapubic catheterization.Conclusion: Most of the CRUI results from technical fault and are potentially preventable.

Bacteriological profile and antibiotic sensitivity pattern of neonatal septicaemia in a rural tertiary care hospital in North India.

Background: There is not much published literature on neonatal septicemia available for the Sub‑Himalayan region of North India. Hence, we undertook this study to find out the bacteriological profile and antibiotic sensitivity pattern of neonatal septicemia in the neonatal Intensive Care Unit. Material and Methods: Blood cultures were performed for all clinically suspected neonatal septicemia cases for 1‑year. Identification of all pathogenic isolates was followed by antibiotic sensitivity testing. Results: We did blood cultures for 450 neonates and 42% were culture positive. Early onset sepsis were 92 (49%) and 96 (51%) were late onset sepsis. Gram‑positive isolates were 60% and 40% were Gram‑negative. Staphylococcus aureus (40%), coagulase negative Staphylococcus species (16%), non‑fermenter group of organisms (NFGOs) (15%), and Klebsiella pneumoniae (10%) were the main isolates. Nasal cannula 101 (54%), birth asphyxia 91 (48%), and prematurity 73 (38%) were the prominent risk factors associated with septicemia. Gram‑positive organisms were highly resistant to penicillin (87%) whereas Gram‑negative isolates showed high resistance to third generation cephalosporins (53–89%) and aminoglycosides (50–67%). The S. aureus isolates were methicillin‑resistant in 41% whereas extended spectrum beta lactamase production was seen in 48% Gram‑negative isolates. Conclusion: Our study highlights the recent emergence of Gram‑positive organisms as predominant cause of neonatal septicemia in this part of Sub‑Himalayan region, along with the review of literature which shows similar results from North India and rest of the world too. Though Gram‑negative bacteria still remain the main cause of mortality in neonatal septicemia, we want to dispel the common notion among practitioners that they are the predominant isolates in neonatal septicemia.

Cherubism – A case report.

Cherubism is an autosomal dominant fibro-osseous lesion of jaws involving more than one quadrant that stabilizes after growth period, usually leaving some facial deformity and malocclusion.Here we present a case of 7 years old male patient who came with complaint of bilateral enlargement of lower face since 4 years. A thorough physical and radiographic examination was done and a diagnosis of cherubism was made.

Estimation of salivary glucose level and plasma glucose level in subjects with and without diabetes mellitus: a comparative study.

Objective: The objective of this study was to estimate and correlate salivary glucose levels and plasma glucose levels in non-diabetic subjects, controlled and uncontrolled diabetic subjects and to assess if salivary glucose can be a potentially useful non-invasive tool in diagnosing diabetes mellitus and in monitoring of glycemic control in diabetic patients. Materials and methods: A total of 90 subjects aged between 40-60 years participated in the study. Diabetic status was determined by estimation of random non-fasting plasma glucose levels and Glycosylated haemoglobin levels. Both unstimulated and stimulated saliva were collected and investigated for glucose levels. Salivary glucose levels were measured using the glucose oxidase method. Results: Salivary glucose levels were significantly higher in diabetics than non-diabetics. Mean un-stimulated salivary glucose level was 1.15 mg/dL in control group, 2.04 mg/dL in controlled diabetic group and 3.99 mg/dL in un-controlled diabetic group. There was a significant positive correlation between salivary and plasma glucose levels. Conclusion: These results show that salivary glucose concentration can be used as a potentially useful non-invasive tool for diagnosing diabetes mellitus and monitoring glycemic control in diabetic patients.

Working Memory Deficits In Obsessive Compulsive Disorder.

Background: Cognitive deficits could be functioning as an intermediate variable between neurological abnormalities and OCD symptoms. There is lack of such data in our country. Aim : To assess the cognitive functioning of a group of patients with OCD and a group of matched normal controls using Spatial Working Memory Test (SWMT). Method : Patients of OCD were screened for selection criteria. Diagnosis of OCD was made on the basis of DSM IV TR. They were assessed using SWMT for neuro-cognitive impairments and compared the same with matched controls. Conclusions : On SWMT, OCD patients showed significant impairment.

Uterine leiomyoma: clinical profile at civil hospital, Ahmedabad.

Introduction: Fibroid is the commonest tumor of the reproductive tract. This study was carried out to observe the frequency of fibroids in relation to age, parity, type and method of diagnosis along with clinical manifestations. Material & Method: The material comprised of 100 specimens of lesions of uterus received from patients admitted in Civil Hospital, Ahmedabad. Among these 37 patients presenting with fibroid uterus were included in the study. All details of the case consisting of age & parity, clinical history, relevant investigations, gross features and microscopic features were noted. Observations: Out of the 100 cases, clinical diagnosis of leiomyoma was made in 30 cases and on confirmatory diagnosis by histopathological analysis leiomyoma was observed in 37 cases. Most cases were found in late reproductive and perimenopausal years (89.19%). Majority was multiparous (81.08%) and 5.41% were nulliparous. Menorrhagia was commonest (40.54%), pain was second common symptom (27.02%). Leiomyomas were multiple in 59.46% and commonest variety was intramural (67.57%). Conclusion: Leiomyomas are found frequently in late reproductive and perimenopausal years. Multiparous patients are found to have fibroids more frequently than nulliparous. Most leiomyoma were intramural. Menorrhagia was the commonest clinical feature observed in leiomyoma cases.

Hypothyroidism: A reversible aetiology of dilated cardiomyopathy.

Hypothyroidism has various cardiovascular manifestations, impairment of LV diastolic function being the commonest. We hereby report a young female who presented to us with features of congestive heart failure and on subsequent work-up she was diagnosed as a case of dilated cardiomyopathy of reversible aetiology, i.e., hypothyroidism.

Clinical and etiological profile of acute febrile encephalopathy in eastern Nepal.

Objective. To investigate the clinical and etiological profile of acute febrile encephalopathy in children presenting to a tertiary care referral center of Eastern Nepal. Methods. 107 children (aged 1 month to 14 yr) presenting to the emergency with fever (> 380 C) of less than 2 wk duration with altered sensorium with/ or without seizure were prospectively investigated for etiological cause. The investigations included blood and CSF counts, blood and CSF cultures, peripheral smear and serology for malarial parasite, and serology for Japanese encephalitis (JE) virus. Other investigations included EEG and CT or MRI wherever indicated. Results. The most common presenting complaints apart from fever and altered sensorium were headache and vomiting. Convulsions, neck rigidity, hypertonia, brisk deep tendon reflexes, extensor plantar response and focal neurological deficits were seen in 50%, 57%, 22.4%, 28%, 39.3% and 9.3% of the subjects, respectively. The diagnoses based on clinical presentation and laboratory findings were pyogenic meningitis in 45 (42%), non JE viral encephalitis in 26 (25%), JE in 19 (18%), cerebral malaria in 8 (7%), herpes encephalitis and tubercular meningitis in 4 (4%) each, and typhoid encephalopathy in 1 case. Conclusion. Pyogenic meningitis and viral encephalitis including JE are the most common causes of acute presentation with fever and encephalopathy. Preventive strategies must be directed keeping these causes in mind.

Cystoid macular edema after bone marrow transplantation.

We report a case of cystoid macular edema in a patient who underwent bone marrow transplant for aplastic anemia. After having ruled out all the other causes of cystoid macular edema, we concluded that it was secondary to the bone marrow transplant. The patient had mild visual impairment and did not recover the lost vision. In this case report, we describe in detail the clinical presentation, follow-up, and course of medication that this patient had. It is an illustrated case report of cystoid macular edema after bone marrow transplant with mild visual impairment and no recovery.